What are eating disorders and how does Kooth help?

By Dr Jeri Tikare, clinical psychologist, Kooth

Eating difficulties are increasingly common, with an estimated 1.25 million people in the UK thought to have an eating disorder (ED).

What is an eating disorder?

It’s helpful to understand that eating behaviours exist on a spectrum, ranging from what’s considered “normal” to a diagnosed eating disorder. Although the terms “eating difficulties” and “eating disorders” are often confused, they describe different levels of seriousness and specific traits related to an individual’s relationship with food and eating habits.

Compared to other mental health issues, EDs may not be as widespread, but they have the highest mortality rates of all mental health conditions [1,3,4] and are, therefore, a major public health concern.

This emphasises the need to offer full support to individuals experiencing eating difficulties or disorders.

Covid and eating disorders

The pandemic had a negative impact on the mental health of many adolescents and young adults, leading to an increase in eating disorder diagnoses and other forms of disordered eating [2]. 

Numerous studies suggest that eating disorders frequently coexist with a variety of other mental health conditions. This overlap presents significant challenges for the timely detection and intervention of these disorders. A range of biopsychosocial factors—encompassing biological, psychological, and social dimensions—contributes to these challenges.

Firstly, biological factors are critical, as individuals at risk for EDs may not display overt physical signs, such as significant weight loss. Secondly, psychological factors, including the stigma associated with EDs and their correlation with anxiety and depression, complicate the situation further. Lastly, social factors, such as cultural attitudes towards food and eating practices, also shape individual experiences of EDs. These interconnected issues can hinder the provision of timely and effective support [2,3].

Research has also demonstrated that early identification and treatment of potential eating disorders can result in improving outcomes, reducing the risk of progression, and increasing the potential for recovery [4,5]. 

Eating difficulties, shame and stigma

People with eating difficulties or who have a diagnosis of an eating disorder often experience a profound sense of shame and self-criticism [6,7]. 

Many people, especially men and boys, may also perceive a stigma surrounding help-seeking. Generally, struggling with feelings of shame and self-criticism may make it harder for people to reach out and talk to friends, family, or healthcare providers about their difficulties. This can prolong suffering, delay timely support, or mean that someone only receives support when they are chronically unwell.  

Kooth is particularly helpful in providing support for people with disordered eating or eating difficulties. Its confidential and anonymous services significantly reduce the barriers that may otherwise prevent people from seeking essential support. 

Freedom through anonymity

Anonymity contributes to a sense of security and facilitates the therapeutic relationship. It allows clients to share their genuine thoughts and emotions without apprehension of being judged based on their physical appearance, conduct, or past experiences.

Anonymity on Kooth’s platform empowers clients by providing a sense of control, a fundamental aspect that could perpetuate eating difficulties and disordered eating. 

Help - on your own terms

With Kooth, people have the freedom to choose which services they want, whether they want to engage with educational content and activities for self-help or connect with peers for support.

Clients can also interact with the service at their own pace and convenience without needing a referral or meeting specific thresholds.

The service also offers same-day access to mental health support. This means that individuals struggling with eating difficulties can receive immediate assistance without having to see their GP, which can often be a barrier to accessing support.

At Kooth, we aim to create a platform that facilitates the transition to other helpful services when needed. We do this by addressing fears, barriers, and resistance and overcoming traditional obstacles to engagement. For instance, we provide valuable resources to guide clients through early discussions with their GP about their eating difficulties, which can be a significant step towards recovery.

As we previously discussed, eating difficulties are often connected to other mental health issues like anxiety, low mood, and sleep problems. For some clients who may not be ready to discuss their eating struggles, Kooth offers a safe space to tackle these challenges, which could lead to them also addressing their eating issues. By recognising and dealing with these other mental health issues, we can help clients start their journey towards recovery and reduce the likelihood of symptoms worsening. 

Transitioning from specialist services

We aim to provide early help to those transitioning from specialised services. Our support also extends to those who are thinking about getting help but may not be ready to visit a doctor or engage in face-to-face services. 

We also support those who are concerned about potential triggers for an eating disorder during significant life events, such as pregnancy. We conduct assessments to help individuals identify problematic aspects of their relationship with food, eating, weight and shape. 

Then, we work with clients to create a plan to address these issues, help them understand the function of their eating difficulties, and identify potential changes and achievable goals. Additionally, we provide education on eating difficulties and collaborate with individuals to develop alternative coping strategies. 

We offer compassionate support, challenge beliefs contributing to eating difficulties, and encourage and support clients as they make changes.

Kooth - a team of professionals

Our practitioners receive ongoing clinical education and training focusing on eating disorders. This training covers essential topics such as the development and impact of eating difficulties, associated risks, and effective intervention strategies. After this comprehensive training, practitioners are encouraged to participate in interactive sessions led by one of the clinical psychologists. The sessions allow them to explore learned concepts further and engage in case studies to deepen their understanding and enhance their skills.

It’s essential for us to acknowledge our limitations, so prioritising safety is a core aspect of our service;  we understand its importance in the care we deliver. Our practitioners continually assess the risks posed by clients’ difficulties, especially concerning eating disorders, such as self-induced vomiting, over-exercising, and restriction. If there are any concerns, our practitioners will request the client’s personal details and consent to share them with external services. 

When we don’t have identifiable information, we collaborate with the individual to minimise risks, create a safety plan, provide psychoeducation, express our concerns, and guide them to relevant services, such as the charity Beat and others. 

As an organisation, we are mindful of the language we use to address eating difficulties. We avoid using the term “eating disorders” unless a client has explicitly informed us of their diagnosis. Additionally, we do not offer physical health monitoring, diagnosis, nutritional or medical advice.

Our support is aligned with the i-THRIVE framework,  helping people stay well, giving advice and referrals, providing targeted help for eating and other mental health issues, and offering specific goal-focused support. We are also committed to keeping all our clients safe by managing any risks posed.

In summary, the challenges associated with eating encompass a spectrum of relatively minor difficulties to those that exert profound physical, emotional, and psychological impacts. Both require some form of assistance to increase the chances of recovery. Kooth can play a vital role in bridging the gap by offering a secure, confidential, and easily accessible platform for individuals dealing with challenges related to their relationship with food. 

Kooth is a safe space which can reduce feelings of isolation, the fear of being judged and instil a sense of security. This can facilitate the development of a therapeutic alliance, enabling the exploration of these challenges and serving as a crucial step in supporting individuals to open up and embark on their path to recovery.

References

[1] A. Hambleton et al, "Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature," Journal of Eating Disorders, vol. 10, (1), pp. 1-132, 2022.

[2] J. Zapata Jose et al, "The mental health consequences of COVID-19 on a sample of health professions students: a mixed methods study," Journal of American College Health, pp. 1-10, 2024.

[3] S. Barakat et al, "Risk factors for eating disorders: findings from a rapid review," Journal of Eating Disorders, vol. 11, (1), pp. 8-31, 2023.

[4] E. Koreshe et al, "Prevention and early intervention in eating disorders: findings from a rapid review," Journal of Eating Disorders, vol. 11, (1), pp. 38-38, 2023.

[5] K. L. Allen et al, "A framework for conceptualising early intervention for eating disorders," European Eating Disorders Review, vol. 31, (2), pp. 320-334, 2023.

[6] D. Nechita, S. Bud and D. David, "Shame and eating disorders symptoms: A meta‐analysis," The International Journal of Eating Disorders, vol. 54, (11), pp. 1899-1945, 2021.

[7] B. M. Williams and C. A. Levinson, "A model of self-criticism as a transdiagnostic mechanism of eating disorder comorbidity: A review," New Ideas in Psychology, vol. 66, pp. 100949, 2022.

[8] M. Matos, M. Coimbra and C. Ferreira, "When body dysmorphia symptomatology meets disordered eating: The role of shame and self-criticism," Appetite, vol. 186, pp. 106552-106552, 2023.